Quality of pancreatic cancer care at Veterans Administration compared with non-Veterans Administration hospitals

Bilimoria, Karl Y.; Bentrem, David J.; Tomlinson, James S.; Merkow, Ryan P.; Stewart, Andrew K.; Ko, Clifford Y.; Prystowsky, Jay B.; Talamonti, Mark S.

doi:10.1016/j.amjsurg.2007.07.012

« Previous Next »The American Journal of Surgery
Volume 194, Issue 5 , Pages 588-593, November 2007

Quality of pancreatic cancer care at Veterans Administration compared with non-Veterans Administration hospitals

Presented at the 31st Annual Surgical Symposium of the Association of VA Surgeons, Little Rock, AR, May 10–12, 2007

Karl Y. Bilimoria, M.D.
- Department of Surgery, Feinberg School of Medicine, Northwestern University, 675 N. St. Clair St, Galter 10-105, Chicago, IL 60611, USA
- Cancer Programs, American College of Surgeons, 633 N. St. Clair St, 25th Floor, Chicago, IL 60611, USA
David J. Bentrem, M.D.
- Department of Surgery, Feinberg School of Medicine, Northwestern University, 675 N. St. Clair St, Galter 10-105, Chicago, IL 60611, USA
James S. Tomlinson, M.D.
- Department of Surgery, University of California, Los Angeles, and VA Greater Los Angeles Healthcare System, 10833 LeConte Ave, Los Angeles, CA 90095, USA
Ryan P. Merkow, M.D.
- Department of Surgery, Feinberg School of Medicine, Northwestern University, 675 N. St. Clair St, Galter 10-105, Chicago, IL 60611, USA
Andrew K. Stewart, M.A.
- Cancer Programs, American College of Surgeons, 633 N. St. Clair St, 25th Floor, Chicago, IL 60611, USA
Clifford Y. Ko, M.D., M.S., M.S.H.S.
- Cancer Programs, American College of Surgeons, 633 N. St. Clair St, 25th Floor, Chicago, IL 60611, USA
- Department of Surgery, University of California, Los Angeles, and VA Greater Los Angeles Healthcare System, 10833 LeConte Ave, Los Angeles, CA 90095, USA
Jay B. Prystowsky, M.D., M.H.P.E.
- Department of Surgery, Feinberg School of Medicine, Northwestern University, 675 N. St. Clair St, Galter 10-105, Chicago, IL 60611, USA
Mark S. Talamonti, M.D.
- Department of Surgery, Feinberg School of Medicine, Northwestern University, 675 N. St. Clair St, Galter 10-105, Chicago, IL 60611, USA
- Corresponding author. Tel.: +1-847-570-2560; fax: +1-847-570-2930.

Received 17 April 2007; received in revised form 27 May 2007

Abstract

Background

National efforts are underway to monitor the quality of patient care at Veterans Administration (VA) hospitals. The objective of this study was to examine treatment utilization and outcomes for localized pancreatic cancer at VA compared with non-VA hospitals.

Methods

Using the National Cancer Data Base, patients with pretreatment clinical stage I/II pancreatic adenocarcinoma were identified. Treatment utilization and outcomes were assessed at VA compared with academic and community hospitals.

Results

Of 35,009 patients, 2% were seen at VA, 38% at academic, and 54% at community hospitals. VA hospitals were more likely to use surgery (odds ratio 2.20, 95% confidence interval 1.73–2.79) and to administer adjuvant chemotherapy (odds ratio 1.77, confidence interval 1.28–2.46) compared with community hospitals. Adjusted perioperative mortality and 3-year survival rates after surgery were similar at VA and academic hospitals.

Conclusions

For localized pancreatic cancer, patients treated at VA hospitals receive stage-specific treatments and have risk-adjusted perioperative and long-term survival rates that are comparable with those for patients treated at academic centers.

Keywords: National Cancer Data Base, Pancreatectomy, Pancreatic neoplasms, Surgery, Veterans Administration Medical Center